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At age 18, "Albert" first entered OT services through an early psychosis program within
one month of the beginning of outright psychotic symptoms: paranoia that others were plotting
to harm him, and delusions that there was a widespread plot by other males around him to
"come on to him sexually" and that he could hear their "sexual thoughts." He had been referred
to the program by a psychiatrist whom Albert had been taken to by his concerned parents.
He had been attending an alternative school, having been suspended from his public high
school for behavioral issues and use of cannabis and alcohol. In hindsight, those behaviors were
most likely his prodromal symptoms of schizophrenia. In the early psychosis program, Albert
had been on antipsychotic medication for approximately two months with a subsequent
decrease in the psychotic symptoms; however, he still heard voices at times, especially when he
was stressed. You are an occupational therapist who will be consulting with the Early Psychosis
team to assist Albert meet his goals, now that his medications have had time to work.
The team including Albert and his family members believed it was best to for him to get
his high school diploma at the local community college. At the community college he could
develop a new clean and sober social group, and have fewer total hours in a structured class
setting. He had to take about 5 classes to be eligible for his diploma, and then these credits
could also be applied to an associate’s degree if he wanted to continue on at the community
college. Albert loved to draw and showed some interest in learning more about graphic design.
During the assessment process, you learned that Albert has difficulty concentrating and
works hard to avoid crowds because he becomes overwhelmed. He also described hesitantly
that he feels like a failure compared to his other siblings who have earned high-achieving
academic accolades. He shared that his little sister was “okay” because she was “into drawing”
and liked creative things. He did think it was a good idea to get his diploma before going on in
college or working. By the end of the interview he shared that he was a “little freaked” by the
diagnosis of schizophrenia and was worried about what new friends would think about his
During your evaluation, the Canadian Occupational Performance Measure showed his
five top goals were coping with voices during his daily routine, making new friends at the
community college because he tends to isolate, focusing during class, focusing on his
homework, and learning how to go more places on the bus and light rail. He knows he cannot
move out now, but feels he needs to get ready by having his parents do less, e.g., not drive him
places. He will be starting with one class (English) at the community college in 2 weeks. Also,
On the Adult sensory profile, Albert scored as “much more than most people” in sensation
avoiding and low registration for auditory processing. On the cognitive disability screening and
the Allen Diagnostic Modules, he scored 5.2.
The occupational therapy services you are providing are paid through ear-marked
funding by the state legislature for early psychosis programs in the community (so it’s
outpatient). (Also, this program pays for doing therapy out in the community). For your this
case, develop a plan for therapy for 2x/wk for 6 weeks.